I am the Executive Director of the National Foundation for American Policy, a non-partisan public policy research organization focusing on trade, immigration and related issues based in Arlington, Virginia. From August 2001 to January 2003, I served as Executive Associate Commissioner for Policy and Planning and Counselor to the Commissioner at the Immigration and Naturalization Service. Before that I spent four and a half years on Capitol Hill on the Senate Immigration Subcommittee, first for Senator Spencer Abraham and then as Staff Director of the subcommittee for Senator Sam Brownback. I have published articles in the Wall Street Journal, New York Times, and other publications. I have written two books, one a non-fiction book called Immigration (2010) and the other a parody novel called The Lord of the Ring Dings (2013).

The author is a Forbes contributor. The opinions expressed are those of the writer.

Doctor, Doctor, Why Won't America Let In More Doctors?

Unless Congress reforms our immigration laws to allow the entry of more foreign-born physicians it will become more difficult to visit the doctor of your choice. The graying of the U.S. population and the Affordable Care Act, known as Obamacare, will increase the demand for medical services. Meanwhile, U.S. immigration laws seem designed to keep out, rather than facilitate, the entry of doctors who want to serve patients in America. (See a new study by the National Foundation for American Policy.)

The handwriting is on the wall. “Finding a doctor will get increasingly difficult, waits for appointments will grow longer, and more sick people will turn to crowded emergency rooms,” according to Ted Epperly, of the American Academy of Family Physicians. “The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed,” reported the New York Times in discussing the impact of President Obama’s health care legislation. “And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care.”

“Severe physician shortages have already hit children,” according to Mark Wietecha, President and Chief Executive of the Children’s Hospital Association, which represents more than 220 children’s hospitals. “Children are struggling to get timely medical care, with some waiting almost four months for subspecialist appointments even in communities served by a children’s hospital.”

In general, a “shortage” normally does not last for a long time in a labor market. However, government actions, such as immigration restrictions, can lead to an undersupply of specialized labor and leave employers with choices that may not be in the best interests of consumers. In other words, “shortages” of doctors and nurses in the United States will appear in the form of longer waits for appointments and subpar medical care for Americans, not empty hospital rooms or vacant medical office buildings.

Prior to 1977, the U.S. immigration system generally permitted the entry and permanent residence of foreign-born physicians. After the passage of the 1976 Health Professions Education Assistance Act, “International Medical Graduates were now subjected to two requirements that dramatically interrupted the free flow of medical talent into the United States,” according to attorney George S. Newman.

First, new credentialing rules made it difficult for International Medical Graduates by requiring testing on material the physician likely studied several years before. Second, prohibitions on using other temporary visa categories in the new law “had the net effect of forcing virtually every International Medical Graduate coming to the United States for graduate medical education into the J-1 visa category, which meant that all of these individuals became subject to the two-year home residence requirement” of the law. While there are ways to overcome this obligation without leaving the country, the number of people who can do so annually under the “Conrad 30 program” is limited.

The main problem with the Conrad 30 program is that 30 J-1 physician waivers per state is too small a number. The largest states, such as Texas, New York and California generally use the 30 slots within days, according to Greg Siskind, partner, Siskind Susser, P.C.

To earn permanent residence an International Medical Graduate generally must agree to work three or five years in an underserved area or Veterans Administration (VA) facility. The requirement is three years if going through the labor certification process and then being sponsored for a green card. It is five years if the physician uses a “national interest waiver.”

There does not appear to be organized opposition to admitting more foreign doctors. Sometimes one will hear a generalized concern about a “brain drain,” but prohibiting foreign physicians from practicing in the United States under such a premise amounts to controlling the lives of ambitious people without due cause. If America does not admit them, then another Western nation will.

Back in the 1970s, some in Congress argued foreign doctors were inferior to U.S.-educated physicians. If that ever was the case, recent research shows that it is not true today. A study in Health Affairs concluded, “Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad.”

To help patients, Congress should expand the number of employment-based green cards so the wait times for skilled immigrants, including nurses, physicians, and physical therapists, can be measured in weeks or months, rather than years or decades. Congress should also vastly expand the Conrad 30 program to include many more physicians per state and in the country as a whole. This will aid patients in underserved areas and enable more U.S.-trained doctors to pursue specialized medical fields. In addition, we should consider methods to overcome the limitations on medical residency slots in the U.S. by developing guidelines to allow foreign-trained doctors to practice in the United States if they can demonstrate a high level of expertise.

While Americans are living longer, they would be living better with a sufficient supply of doctors, nurses and other medical personnel. U.S. patients and hospitals have waited decades for Congress to reform the immigration system for professionals in the health care system. The need is evident and the reforms are straightforward. Americans will continue to suffer the medical consequences unless Congress and the executive branch act on such reforms.

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